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Free Paint Program Application

Please correct the field(s) marked in red below:

1
Name
 *
2
Address
 *
3
Email
4
Phone Number
 *
5
Date
 *
6
General Information
General Information
Yes No
Are you a resident of the City of Charlottesville?
Do you own or rent the house you intend to paint?
Do you live in the house you intend to paint?
Have you received paint through the Free Paint Program in the past 3 years?
7
If you have received paint from this program in the past 3 years, describe what portions of your home have been painted with materials from the Free Paint Program.
8
What portions of your home do you intend to paint using materials from the Free Paint Program?
9

The Free Paint Program requires that painting projects using materials received from the program be completed within 90 days of delivery.  Can you meet this requirement?

 *
The Free Paint Program requires that painting projects using materials received from the program be completed within 90 days of delivery. Can you meet this requirement?
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